Funktionelles Ergebnis nach erster und mehrfacher intrazerebraler Blutung bei Patienten mit einer kavernösen Hirnstamm-Malformation

Brainstem cavernous malformations (BSCM) can be related to spontaneous intracerebral hemorrhage (ICH). The aim of this study was to assess the natural course of disease and to identify predictors of functional neurological outcome after single and multiple bleeding events.

We included BSCM patients with complete baseline characteristics, MRI dataset, ≥1 ICH, and ≥1 follow-up examination treated between 2003 and 2022. Functional neurological outcome was obtained using the modified Rankin Scale (mRS) at diagnosis, before and after each ICH, and last follow-up.

A total of 265 patients were included. Functional neurological outcome deteriorated in 40.2% (P=0.003) after the second bleeding event and in 44.8% (P =0.038) after the third bleeding event. Moreover, the functional neurological status was reduced in 15.8% (P<0.001) of patients at last available follow-up compared to the time of BSCM diagnosis.

ICH due to a BSCM generally implies neurological deterioration. Our study shows that functional outcome tends to improve after each bleeding event, but with each ICH the chance of full recovery decreases. Bleeding was significantly associated with neurological deterioration compared to initial ICH. This deterioration is further accentuated after subsequent hemorrhagic events.